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Diagnosis & Staging

Many men come to Memorial Sloan Kettering because they detect a lump or swelling in one of their testicles. During your first appointment, your doctor will perform a comprehensive physical examination. This includes examining your testicles for any abnormalities and your abdomen to identify enlarged lymph nodes.

Our doctors perform blood tests to measure levels of certain proteins called tumor markers. High levels of tumor markers – including beta-human chorionic gonadotropin (beta-hCG), alpha-fetoprotein, and lactate dehydrogenase – may indicate the presence of testicular cancer and can help doctors determine your prognosis. However, blood tests alone cannot provide a definitive diagnosis because testicular cancer does not always raise the levels of these tumor markers.

Depending on the results of your physical exam and blood tests, our doctors may also perform imaging tests, including:

ultrasound, in which high-frequency sound waves map the location of tumors within the testicle and allow doctors to distinguish cancerous tumors from non-cancerous growths

CT scans, which may reveal whether a tumor has spread to the lymph nodes or other areas of the body

Surgery to Identify Your Tumor Type

If tests find that a tumor is present, your doctor will usually recommend surgery to remove the affected testicle through a procedure called radical orchiectomy. Pathologists with expertise in analyzing testicular tissue will examine the tumor under a microscope to determine the type of testicular cancer that you have. Our pathologists are highly experienced in distinguishing among seminomas, nonseminomas, and less common types of testicular tumors. Knowing the tumor type is critical for doctors to select the best treatment or combination of therapies for you.

Many men with testicular cancer come to Memorial Sloan Kettering for treatment after they have undergone a radical orchiectomy elsewhere. In most cases, our pathologists can reexamine the tumor tissue that was removed to confirm your initial diagnosis. If the testicular tumor tissue is not available for our pathologists to study, or if a tumor is not present in the testicle during your examination, our physicians may recommend a biopsy of abnormal lymph nodes in your groin or abdomen, or a biopsy of a tumor located elsewhere, to make an accurate diagnosis.

Staging

If diagnostic tests indicate that you have a germ cell tumor, your doctor will use this information to determine the stage of your tumor (how advanced it is) and select the best treatment approach.

Our doctors use the TNM staging system, developed by the American Joint Committee on Cancer. The stage depends on your testicular tumor’s size (T), whether the cancer has spread to the lymph nodes in the pelvis or abdomen (N), and whether the tumor has metastasized (M) to other parts of the body. Doctors also consider your blood serum (S) marker levels.

Testicular cancer can be classified into three stages.

Stage I – Testicular cancer is confined to the testicle, with no evidence that it has spread to nearby lymph nodes or other organs.

Stage II – The tumor has spread to lymph nodes in the abdomen or pelvis.

Stage III – Cancer has spread to lymph nodes in the chest, lungs, or more distant organs such as the liver, bones, or brain.

Letters such as A, B, and C may be added to each of these stage numbers to more precisely describe the extent of the tumor.

Medical oncologist Dean Bajorin is part of our team of experts who diagnose and treat nearly 300 men who are newly diagnosed with testicular cancer each year.